At the Front Lines of San Diego’s Hepatitis A Outbreak

By
Heather Buschman, PhD |
October 27, 2017

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​San Diego County is in the midst of an outbreak of hepatitis A, a viral infection spread person-to-person and through contact with fecally contaminated objects or food. As of October 24, more than 516 people have been infected and 19 have died.

UC San Diego Health physicians, nurses and staff are at the forefront. Since March 2017, 132 patients were diagnosed with hepatitis A at UC San Diego Health.

“In addition to treating hepatitis A patients who come to us, our goal is to identify and vaccinate as many people as we can who may be at increased risk for this infection,” said
Randy Taplitz, MD, clinical director of the Division of Infectious Diseases at UC San Diego Health. “To that end, we’re working closely with San Diego County and City and we’ve implemented hepatitis A education and vaccination programs throughout our health system and community locations.”

In the past five months, UC San Diego Health staff have vaccinated more than 4,270 community members and 2,227 UC San Diego Health employees — a large collaborative effort that involves our Emergency Department, nurses in primary care offices, pharmacists in outpatient pharmacies and many others. The team is also distributing information and hygiene kits to patients who need them.

The current outbreak has predominantly affected people who are homeless or use illegal drugs, and these groups are now considered at highest risk for the infection.

For Danisha Jenkins, nurse manager of the Trauma Progressive Care Unit at UC San Diego Medical Center in Hillcrest, this outbreak hits especially close to home. In a typical week, her department treats eight to 10 patients who are homeless.

“Part of being a nurse is not just caring for the illness or injury of the moment, but taking a holistic approach to understanding your patients' issues, challenges and risks when they leave the hospital,” Jenkins said. “In recent months, the high risk of hepatitis A has become one of those issues for many of our patients.”

Early in the outbreak, Jenkins proactively reached out to the San Diego County Health and Human Services Agency to see what resources were available. They provided Jenkins’ team with free hygiene kits, which they are now being given to at-risk patients. The kits contain hand-sanitizing cloths, fresh water, hand sanitizer, waste bags and information sheets that list the symptoms of hepatitis A and where people should go if they experience them. The team has also been offering hepatitis A vaccines to their patients.

“Our patients have been very thankful for the information and the opportunity to get vaccinated—for many homeless people, especially those with mental illnesses, they don’t know about the outbreak or what they can do, and they don’t always have the means to get vaccinated elsewhere,” Jenkins said.

Similar education and vaccination efforts are being offered to appropriate patients at UC San Diego Health’s Emergency Departments, urgent care facility, ambulatory clinics and influenza vaccination drives, as well as at the School of Medicine’s two Student-Run Free Clinics, which serves many homeless and other high-risk patients.

There is little research on hepatitis A. Naveen Gara, MBBS, a hepatologist at UC San Diego Health, said that’s likely because, for most healthy people without underlying health conditions, the infection runs its course and the virus is cleared without long-term health effects. That makes it different than hepatitis B or C, which are chronic diseases caused by different viruses.

According to Taplitz, the San Diego hepatitis A outbreak has not yet peaked, and is expected to continue for several months before it’s over.

“As an academic health system and a public institution, we have a long history of caring for the region’s most vulnerable patients and underserved populations, and we will continue to do so,” she said.

HEPATITIS A FAQs

How is hepatitis A spread? Typically when a person ingests the virus from contact with objects, food or drink contaminated with feces from an infected person. In some cases, the virus is blood-borne.

What are the symptoms? Fever, fatigue, nausea, vomiting, loss of appetite, abdominal pain, dark urine, light stool and yellow eyes. Symptoms generally start two to six weeks after an exposure.

How can I prevent the spread of hepatitis A? Primarily through excellent personal hygiene and sanitation, including hand washing after using the bathroom, changing diapers and before preparing or eating food. Environmental surfaces can be cleaned with a freshly prepared solution of 1:100 dilution of household bleach. An effective vaccine against hepatitis A is also available.

Who should get vaccinated? Hepatitis A vaccination is recommended for those at highest risk of contracting the infection—people who may be homeless, those who are dependent on alcohol or illicit intravenous or non-injection drugs, men who have sex with men, people who suffer from liver diseases (cirrhosis, hepatitis B or hepatitis C), people who have clotting factor disorders, and those traveling to countries that have high hepatitis A rates. Health care, social and public health workers are also at increased risk. The vaccine is being provided to UC San Diego Health employees and patients. If you feel you are at increased risk of infection, please call your primary care provider.